Malaria or just fever?

A 35 y/o man is brought to the ED by friends and left there alone, he has high fever, he is from Ghana and he has just arrived, he speaks english not so well and he is confused and agitated, so anamnesis is very difficult and you catch a only word “malaria”, you also know…

ByIlenia Spallino16 February 20130Comments

Chest

Useless ECG?

A 67 y/o man arrives to the ED by ambulance because of precordial pain since half an hour, during the transport, paramedics perform an ECG that shows a left bundle branch block (LBBB), that patient refers in his history. They find it unuseful and so they do not transmit it to the cardiologist, is it…

ByIlenia Spallino15 January 20130Comments

Chest Ultrasound

Pleuritic Pain, the end of the saga…

A 33 y/o woman, comes to the ED because of a sudden emithorax pain on the left in basal region. The pain is described as stabbing, well localized, it worsen with inspirium …a pleuritic pain, no cough, no fever, not hemoptysis. She smokes, she does not take any medication. Chest x ray is normal.…

ByIlenia Spallino17 November 20120Comments

Chest

What does it hide behind a negative X-Ray?

A 33 y/o woman, comes to the ED because of a sudden emithorax pain on the left in basal region. The pain is described as stabbing, well localized, it worsen with inspirium …a pleuritic pain, no cough, no fever, not hemoptysis. She smokes, she does not take any medication. Chest x ray is normal.…

ByIlenia Spallino27 October 20120Comments

Chest

Pleuritic pain and radio-occult lesion

A 33 y/o woman, comes to the ED because of a sudden emithorax pain localized on the left in basal region. The pain is described as stabbing, well localised, it worsen with inspirium …a pleuritic pain, no cough, no fever, not hemoptysis. She smokes, she does not take any medication. Chest x ray is normal.…

ByIlenia Spallino11 October 20120Comments

Chest Ultrasound

Can Ultrasound rule out a pneumothorax?

Y ou are allerted for a level 3 trauma from the mountain, a cyclist has fallen going down hill. You prepar the shock room with everything you may need, dress up, and wait. A 25 y/o cyclist arrives completely immobilized, you immidiately start to perform ABCDE as you learned in your recent ATLS course (you…

ByIlenia Spallino10 July 20120Comments

Chest

Thoracic trauma and chest X-Ray

Y ou are alerted for a level 3 trauma coming from the mountain, a cyclist has fallen going down hill. You prepare the shock room with everything you may need, dress up, and wait. A 25 y/o cyclist arrives completely immobilized, you immediately start to perform ABCDE as you learned in your recent ATLS course…

ByIlenia Spallino10 July 20120Comments

Abdomen

Rectal Examination and Appendicitis

A 25 y/o man comes to the ED because of abdominal pain started 2 hours before, fever and vomit. He has not history of disease, no history of surgery, no history of other ED admission for abdominal pain. Clinical examination shows rigidity and diffused painfull abdomen. You perform digital rectal examination were you evidence no…

ByIlenia Spallino18 March 20120Comments

Abdomen

Bowel obstruction and physical examination

A 75 y/o man arrives in ED from a nursing. He complains abdominal pain. No fever, no jaundice, abdomen presents distended. Inspection shows a midline old scar, there is diffuse rigidity, increased bowel sounds and vomit on the sheets. Can history and clinical examination contribute to diagnosis of bowel obstruction? …

ByIlenia Spallino10 February 20120Comments

Bones and joints Ultrasound

Septic Arthritis and Arthrocentesis

A 33 y/o male comes to the ED for fever, knee swelling and pain. He has a history of joint surgery because of trauma, and prothesis, dating 4 years before. He is HIV positive He presents feverish (38°C), the left knee is swollen and hot. WBC 34.000/μL, CRP 109 mg/L, PCT 0,05 ng/mL. As we…

ByIlenia Spallino26 January 20120Comments